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The first-line pharmacologic therapy for heart failure is typically ACE inhibitors. These medications are fundamental in managing heart failure due to their ability to reduce morbidity and mortality associated with the condition. ACE inhibitors work by inhibiting the angiotensin-converting enzyme, leading to vasodilation and a decrease in fluid retention. This helps to alleviate the workload on the heart and improves overall cardiac function.

Diuretics, while they are important in managing symptoms of heart failure such as fluid overload, are not considered first-line treatment aimed at modifying the course of the disease. They primarily provide symptomatic relief by promoting fluid excretion, which helps reduce edema and congestion but does not impact survival rates or long-term outcomes in the same way that ACE inhibitors do.

Beta-blockers are also an essential part of heart failure management but are typically introduced after the stabilization of the patient, making them a second-line option in the acute setting. Calcium channel blockers are not generally recommended for heart failure treatment due to potential negative effects on heart contractility and increased risk of adverse outcomes in this patient population.